Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Linguistic analysis of empathy in medical school admission essays.

OBJECTIVES: This study aimed to determine whether words used in medical school admissions essays can predict physician empathy. METHODS: A computational form of linguistic analysis was used for the content analysis of medical school admissions essays. Words in medical school admissions essays were computationally grouped into 20 'topics' which were then correlated with scores on the Jefferson Scale of Empathy. The study sample included 1,805 matriculants (between 2008-2015) at a single medical college in the North East of the United States who wrote an admissions essay and completed the Jefferson Scale of Empathy at matriculation. RESULTS: After correcting for multiple comparisons and controlling for gender, the Jefferson Scale of Empathy scores significantly correlated with a linguistic topic (r = .074, p < .05). This topic was comprised of specific words used in essays such as "understanding," "compassion," "empathy," "feeling," and "trust." These words are related to themes emphasized in both theoretical writing and empirical studies on physician empathy. CONCLUSIONS: This study demonstrates that physician empathy can be predicted from medical school admission essays. The implications of this methodological capability, i.e. to quantitatively associate linguistic features or words with psychometric outcomes, bears on the future of medical education research and admissions. In particular, these findings suggest that those responsible for medical school admissions could identify more empathetic applicants based on the language of their application essays.

Predicting risk of hospitalisation: a retrospective population-based analysis in a paediatric population in Emilia-Romagna, Italy.

OBJECTIVES: Develop predictive models for a paediatric population that provide information for paediatricians and health authorities to identify children at risk of hospitalisation for conditions that may be impacted through improved patient care. DESIGN: Retrospective healthcare utilisation analysis with multivariable logistic regression models. DATA: Demographic information linked with utilisation of health services in the years 2006-2014 was used to predict risk of hospitalisation or death in 2015 using a longitudinal administrative database of 527 458 children aged 1-13 years residing in the Regione Emilia-Romagna (RER), Italy, in 2014. OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in 2015 for problems that are potentially avoidable were developed and evaluated using the C-statistic, for calibration to assess performance across levels of predicted risk, and in terms of their sensitivity, specificity and positive predictive value. RESULTS: Of the 527 458 children residing in RER in 2014, 6391 children (1.21%) were hospitalised for selected conditions or died in 2015. 49 486 children (9.4%) of the population were classified in the 'At Higher Risk' group using a threshold of predicted risk >2.5%. The observed risk of hospitalisation (5%) for the 'At Higher Risk' group was more than four times higher than the overall population. We observed a C-statistic of 0.78 indicating good model performance. The model was well calibrated across categories of predicted risk. CONCLUSIONS: It is feasible to develop a population-based model using a longitudinal administrative database that identifies the risk of hospitalisation for a paediatric population. The results of this model, along with profiles of children identified as high risk, are being provided to the paediatricians and other healthcare professionals providing care to this population to aid in planning for care management and interventions that may reduce their patients' likelihood of a preventable, high-cost hospitalisation.

The predictive validity of three versions of the MCAT in relation to performance in medical school, residency, and licensing examinations: a longitudinal study of 36 classes of Jefferson Medical College.

PURPOSE: The Medical College Admission Test (MCAT) has undergone several revisions for content and validity since its inception. With another comprehensive review pending, this study examines changes in the predictive validity of the MCAT's three recent versions. METHOD: Study participants were 7,859 matriculants in 36 classes entering Jefferson Medical College between 1970 and 2005; 1,728 took the pre-1978 version of the MCAT; 3,032 took the 1978-1991 version, and 3,099 took the post-1991 version. MCAT subtest scores were the predictors, and performance in medical school, attrition, scores on the medical licensing examinations, and ratings of clinical competence in the first year of residency were the criterion measures. RESULTS: No significant improvement in validity coefficients was observed for performance in medical school or residency. Validity coefficients for all three versions of the MCAT in predicting Part I/Step 1 remained stable (in the mid-0.40s, P < .01). A systematic decline was observed in the validity coefficients of the MCAT versions in predicting Part II/Step 2. It started at 0.47 for the pre-1978 version, decreased to between 0.42 and 0.40 for the 1978-1991 versions, and to 0.37 for the post-1991 version. Validity coefficients for the MCAT versions in predicting Part III/Step 3 remained near 0.30. These were generally larger for women than men. CONCLUSIONS: Although the findings support the short- and long-term predictive validity of the MCAT, opportunities to strengthen it remain. Subsequent revisions should increase the test's ability to predict performance on United States Medical Licensing Examination Step 2 and must minimize the differential validity for gender.

Components of postgraduate competence: analyses of thirty years of longitudinal data.

CONTEXT: The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment. OBJECTIVE: We aimed to examine the major components and correlates of postgraduate competence in patient care. METHODS: A 24-item rating form with additional questions about resident doctors' performance and future residency offers was used. Study participants comprised 4560 subjects who graduated from Jefferson Medical College between 1975 and 2004. They pursued their graduate medical education in 508 hospitals. We used a longitudinal study design in which the rating form was completed by programme directors to evaluate residents at the end of the first postgraduate year. Factor analysis was used to identify the underlying components of postgraduate ratings. Multiple regression, t-test and correlational analyses were used to study the validity of the components that emerged. RESULTS: Two major components emerged, which we labelled 'Knowledge and Clinical Capabilities' and 'Professionalism', and which addressed the science and art of medicine, respectively. Performance measures during medical school, scores on medical licensing examinations, and global assessment of Medical Knowledge, Clinical Judgement and Data-gathering Skills showed higher correlations with scores on the Knowledge and Clinical Capabilities component. Global assessments of Professional Attitudes and ratings of Empathic Behaviour showed higher correlations with scores on the Professionalism component. Offers of continued residency and evaluations of desirable qualities were associated with both components. CONCLUSIONS: Psychometric support for measuring the components of Knowledge and Clinical Capabilities, and Professionalism provides an instrument to empirically evaluate educational outcomes to medical educators who are in search of such a tool.

Volunteer bias in medical education research: an empirical study of over three decades of longitudinal data.

CONTEXT: The issue of whether medical education research outcomes can be biased by students' refusal to allow their data to be used in outcomes research should be empirically addressed to assure the validity of research findings. Given that institutions are expected to document the outcomes of their educational programmes, evaluations of clinical performance subsequent to medical school are crucial, but are often incomplete when graduates decline to permit data collection. OBJECTIVES: This study aimed to examine the demographic and performance differences between research volunteers and others. METHODS: A total of 7415 doctors graduated from Jefferson Medical College between 1970 and 2004; 75% (n = 5575) agreed to participate in medical education research by granting written permission for the collection of data from their postgraduate training directors on their behalf (research volunteers); 20% (n = 1489) refused to grant such permission (non-volunteers), and 5% (n = 351) did not return the permission form (non-respondents). This prospective longitudinal study compared research volunteers, non-volunteers and non-respondents on gender, ethnicity, performance measures prior to, during and after medical school, scores on medical licensing examinations, and board certification status. RESULTS: Doctors who granted permission (volunteers) generally performed better during and after medical school. In addition, they scored higher on medical licensing examinations and had a higher certification rate. Women and members of ethnic minority groups were less likely to grant permission. CONCLUSIONS: The study raises questions about the validity of research findings as a result of volunteerism in medical education research. The implications for guidelines regarding the protection of human subjects in medical education research, and for educational outcomes, are discussed.

Economic diversity in medical education: the relationship between students' family income and academic performance, career choice, and student debt.

Providing access to higher education across all income groups is a national priority. This analysis assessed the performance, career choice, and educational indebtedness of medical college students whose educational pursuits were assisted by the provision of financial support. The study looked at designated outcomes (academic performance, specialty choice, accumulated debt) in relation to the independent variable, family (parental) income, of 1,464 students who graduated from Jefferson Medical College between 1992 and 2002. Students were classified into groups of high, moderate, and low income based on their parental income. During the basic science years, the high-income group performed better; however, in the clinical years, performance measures were similar. Those in the high-income group tended to pursue surgery, while those in the low-income group preferred family medicine. The mean of accumulated educational debt was significantly higher for the low-income group. The study provides support for maintaining economic diversity in medical education.

Medical education and health services research: the linkage.

The medical community is coming under increased scrutiny. Challenges to the integrity of the healthcare system have been raised due to reports about the prevalence of medical errors. A heightened level of vigilance is required. Equally important is the need to isolate and correct the source of any problem, perceived or real. We are faced with challenging questions. Is the selection of students and residents appropriate? Are their education and evaluation valid? These questions must be answered at least in part by understanding the climate in which the services to the patients are rendered. Otherwise deficiencies noted in practice may be inappropriately attributed to the educational process. This article addresses the importance, implications and impact of the link between medical education and health services research. The goal of medical education is to prepare physicians to meet the challenges of practice by fulfilling their roles of clinician, educator and resource manager. Health services research can be linked to any of these physician roles. An understanding of health services is necessary to assess how well this goal is being met in the context of the changing healthcare system. A partnership between medical education and health services research is essential for academic health centers and health services institutions in assessing issues of health manpower and for the public good. Academic health centers have an important role in this partnership providing an infrastructure and expertise for both education and health services research.

African American and white physicians: a comparison of satisfaction with medical education, professional careers, and research activities.

BACKGROUND: Given the disparity between proportions of minority in the general population and in the physician workforce and the projected increase in the minority population, it is important and timely to examine factors that contribute to satisfaction of minority physicians. PURPOSE: To examine similarities and differences between African American and White physicians in their satisfaction with medical school, their medical careers, and their professional and research activities and achievements. METHODS: A questionnaire was mailed to the 148 active African American graduates of Jefferson Medical College (1960 to 1995). Control group was 148 active White classmates matched as to gender, year of graduation, and scores on Step 2 of the United States Medical Licensing Examination (formerly Part 2 of the National Board). RESULTS: Overall response rate--61% (African Americans--59%, White control group--63%). Both groups were equally satisfied with medical education, careers, and professional and research activities. No differences were noted between the groups in satisfaction with medical school financial support, preparation for a medical career, the educational experience and academic environment, medical careers, and practice incomes. African Americans reported greater dissatisfaction than Whites with interactions with medical school faculty and administrators and with the medical school social environment. African Americans were less likely than Whites to recommend Jefferson to minority applicants and to contribute to annual alumni giving. More African Americans than Whites practiced medicine in economically deprived areas and cared for poor minority patients. CONCLUSIONS: African American respondents were comparable with White respondents as to their medical careers, professional activities, and achievements as physicians. Their practice patterns reflected a greater sense of community need and involvement than their White counterparts. The sense of dissatisfaction with the social environment of medical school noted by African American respondents seems to persist during their professional careers.

Conceptualization and measurement of clinical competence of residents: a brief rating form and its psychometric properties.

Conceptualization and measurement of clinical competence of residents are of interest to medical educators. Yet there is a scarcity of operational tools with satisfactory psychometric support for measuring clinical competence. In this study, we investigated the underlying structure, criterion-related validity and alpha reliability of a brief rating form (20 items) developed to assess clinical competence of residents. The study sample consisted of 882 physicians (654 men, 228 women) in postgraduate training at Thomas Jefferson University Hospital between 1998 and 2000. Construct validity of the form was supported by factor analysis. Two relevant factors emerged: 'Knowledge, Data-Gathering and Processing Skills', and 'Interpersonal Skills and Attitudes'. Criterion-related validity was supported by significant linear associations between factor scores and performance on the medical licensing examinations. Alpha reliability coefficients for the two factors were 0.98 and 0.97, respectively. This brief rating form can be employed as one measure to evaluate clinical competence of residents with reasonable confidence in its measurement properties.